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• 1 <br /> STATE OF COLORADO <br /> MINED LAND RECLAMATION DIVISION 4 Co <br /> Department of Natural Resources ��4' <br /> 1313 Sherman St.,Room 215 <br /> Denver,CO 80203 + '► <br /> 303 866-3567 `1876` <br /> Fax: 303 832-8106 <br /> Eby Romer. <br /> Governor <br /> Fred R.Santa, <br /> APPLICATION FORM FOR A REVISION UiiwsionDirector <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests for minor <br /> revisions , as defined in Rule 1 .04(73), technical revisions as defined in <br /> Rule 1 .04(36) and permit revisions, as defined in Rule 1 .04(90) . All <br /> revisions are to address the requirements of Rule 2.08.4. Three (3) copies of <br /> your revision including maps must be submitted in order for it to be complete. <br /> All revisions are to be formatted so they can be inserted into the permit to <br /> replace the revised sections, maps , tables and/or figures. Explain in the <br /> revision what section is being revised. The revision date should be printed <br /> in the lower right corner of the revision pages. If necessary, the Table of <br /> Contents should also be revised. When the final version of the revision is <br /> approved, 7 copies must be sent to OSM in Denver for Federal mines and for <br /> non-Federal mines 1 copy must be sent to OSM at 625 Silver Avenue, SW, Suite <br /> 310, Albuquerque, New Mexico 87102. The revision may not proceed until OSM <br /> has been provided copies. Copies should be sent certified mail . <br /> Permit No.: C - J_ - p_ J_ 7 <br /> Date: —9_/ _ / t. .. A-. <br /> Permittee: sL-Cal1tirri�Resc�urr.�s_ n <br /> Street: <br /> P.O. Box 1298 _ <br /> City: G1PsawG6Qd.sl-r-in3s-r -C-O— — <br /> State: =C O Zip Code: 8 1 6 0 2 - _ <br /> Mine Name: Coal Basin Mine <br /> Brief Description of Revision: Route water to second pond =0�§ <br /> Public Notice Attached - Yes i No . — (Required for PR's and TR's) <br /> Bond Increase: Yes No Federal Non-Federal Mine <br /> Proposed Change in: <br /> Disturbed Area (+/-) _ Acres Affected Area (+/-) _ Acres <br /> Permit Area (+/-) _ i i i Acres Federal Land (+/-) i Acres <br /> State Land (+/-) Acres Private Land (+/-) Acres <br /> 6185F (10/90) <br />